Provider Demographics
NPI:1972678522
Name:HOLDEN, KELLEY (MA, FAAA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2086
Mailing Address - Country:US
Mailing Address - Phone:650-299-2977
Mailing Address - Fax:650-299-2990
Practice Address - Street 1:1800 BROADWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2086
Practice Address - Country:US
Practice Address - Phone:650-299-2977
Practice Address - Fax:650-299-2990
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1842, AU805237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter